Individual
DR. JOHN ANTON FACKENTHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1312 E ISAACS AVE, WALLA WALLA, WA 99362-2152
(509) 252-4100
(509) 529-7033
Mailing address
1312 E ISAACS AVE, WALLA WALLA, WA 99362-2152
(509) 525-4100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP00000703
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1252808
—
WA
01
—
G8850948
MEDICARE GROUP PIN
WA
Enumeration date
12/22/2005
Last updated
01/03/2013
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us